Q3: I’m frustrated by doctors not diagnosing my condition of shortness of breath for nine years. Previously my PFT and heart echo/ECG etc. were normal although I was very short of breath. Blood glucose was fine. I was labelled as hyperventilating. I have since undergone several more tests over the years, including CT scan of chest, a neurological check up to rule out myasthenia gravis.

Two years ago I had an acute shortness of breath (I have all the time but this time was real bad) - my PFT showed that I had low FEV1 of around 60% of the normal, but also my FVC was around the same range. This indicated negative against obstruction. A bronchodilator test showed no improvement in my FEV1. CT scan and blood tests showed no restrictive airway disease.

I’ve been in South Korea for a year. The winter is particularly cold, and I was sick. Two out of three doctors said I had no asthma, a senior doctor gave me steroid/ bronchodilator combo (kind of Advair) and I am not sure if it is working at all. Bronchodilators never worked. My peak flow went down to 350.

Particularly for a few years I have noticed that I get anxiety and hyperventilation happens when I’m hungry, although my blood glucose is always normal (albeit at a lower normal range, I tend to get asthma-like symptom). During these times I get low peak flows which improve with eating but the improvement is never like a normal me. I mean I used to run half a marathon. Now I can’t walk five minutes without getting short of breath. My chest has no wheezing which confuses the doctors. What is wrong with me? Name and address withheld

A3: I am sorry to hear of your long story of breathlessness. Without seeing you it is impossible to even start to speculate about the cause. It is fair to say in defence of my medical colleagues that causes of breathlessness can be puzzling.

It is always important to know whether breathlessness came on suddenly or had been slowly increasing. If it was a sudden onset was their anything associated with it such as an infection? Had you been exposed to any noxious chemicals? Has there been any increase in your weight? An expanding waist line causes an increase in breathlessness.

Any change in lifestyle such as taking more exercise that might uncover a slowly increasing breathlessness that would have otherwise remained unnoticed? Do you take as much exercise as your contempories or are you unfit? To stay fit it only needs half an hours brisk walk daily.

A possibility that may have been overlooked, although you have made some reference to it by mentioning hyperventilation, is that it could be the result of psychological pressures. These are often the cause of hyperventilation and the sensation of breathlessness (air hunger). As you have changes in some of your pulmonary function tests this would seem to be unlikely to be the sole cause in your case.

You haven't told us your age. Remember that emphysema comes on very gradually over a period of many years. There are also a few rarer causes of breathlessness that regularly catch doctors out. These include fibrosing alveolitis or an allergic alveolitis, for some reason these two conditions that result in progressive lung disease seem to be becoming more common.

Your doctors have obviously excluded heart failure and anaemia as causes of breathlessness. I am sorry not to be of more use.

Q4: I tend to find that I am awfully congested throughout the day, finding that my cyanosis tend to be feel very restricted, and that I have a lot of phlegm on my chest constant thought the day, causing me to clear my throat all day long. This condition developed after I had my nose cauterised some years ago after finally getting my GP to agree to do it. They had been promising to do it when I grew up since I was six or seven as I regularly had ten to 20 nose bleeds a day.

I now find that the first thing I do in the morning is spend the first few minutes clearing my throat from the congestion that has built up over night. I did see my GP and was prescribed flixonase, thou I have found that all this really does is concentrate my throat clearing to one half hour in the morning. My nose still feels blocked up, I still have to clear my throat thought out the day of phlegm but nowhere near as often as without the flixonase.